2 to 3% of All New Visceral Cancers Peak Incidence is 6th Decade M:F = 2:1 Grossly is a Bright Yellow, Necrotic Mass with a Pseudocapsule

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1 GENITOURINARY PATHOLOGY Kathleen M. O Toole, M.D. Renal Cell Carcinoma 2 to 3% of All New Visceral Cancers Peak Incidence is 6th Decade M:F = 2:1 Grossly is a Bright Yellow Necrotic Mass Grossly is a Bright Yellow, Necrotic Mass with a Pseudocapsule 1

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4 Histologic Subtypes Conventional RCC Clear cell, granular cell, spindle cell Papillary RCC Chromophobe cell RCC Polygonal cell, eosinophilic cell Collecting Duct Carcinoma 4

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7 RCC Associations Classic Triad = (19%) = Hematuria, Abdominal Mass and CVA Pain Paraneoplatic Syndromes = 25% Hypertension, Cushing s Syndrome, Polycythemia, Hypercalcemia von Hippel-Lindau Disease Amplification of c-myc Expression 7

8 MOLECULAR GENETICS CRC: 3p-, other losses/gains Papillary: 7+, 17+, 3+, Y-, t(x;1), t(x;17) Chromophobe: h Y-,1-, 2-, 6-,10-, 13-,17-,21-17 Collecting Duct: 1-, 6-, 14-,15-, 22- Metastases from CA of Kidney Typically, blood-borne metastasis Lungs Brain Bone Unusual sites Lymphatic metastasis Regional nodes Para-aortic nodes 8

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11 Nephroblastoma, (Wilms Tumor) 85% of Malignant Pediatric Renal Neoplasms Age 2-5 Years 5% Bilateral; 5% Multicentric Large, Circumscribed and Lobulated Mass Triphasic Histology, with Blastemic, Epithelial and Stromal Elements Prognosis Depends on Stage, and Presence of Anaplasia 11

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13 Wilms Tumor Associations Sporadic Aniridia Hypogenitalism Mental Retardation Urogenital Tract Anomalies Dlti Deletion of fchromosome 11p Beckwith-Wiedmann Syndrome Drash Syndrome 13

14 TNM System STAGING - T (extent of local spread) - N (presence or absence of regional node mets) - M (presence or absence of distant metastasis) Oncocytoma Strict Diagnostic Criteria Must be Used Grossly Consists of a Well Circumscribed, Mahogany-Brown, Bosselated Mass, with a Central Stellate Scar Histologically Comprised of Nests, Trabecular and Tubular Structures Made Up of Large, Polygonal Cells with Eosinophilic Granular Cytoplasm Clear Cell Differentiation, Necrosis, or Papillary Architecture Rule Out Diagnosis 14

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16 Angiomyolipoma 50% Are Associated With Tuberous Sclerosis Grossly Single to Multiple Bright Yellow Neoplasms, Which Vary in Size Histologically Comprised of Large, Thick-Walled Blood Vessels, Mature Smooth Muscle and Adipose Tissue Controversy- Neoplasm vs Hamartoma 16

17 MISCELLANEOUS RENAL MASSES Soft tissue tumors Benign, malignant Metastatic carcinoma Malignant Lymphoma 17

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20 PENILE NEOPLASMS Benign- condyloma HPV associated, serotypes 6 and 11 Malignant- squamous cell carcinoma Uncircumcised penises High incidence in South America, Africa, Asia (not Japan) Often HPV associated, serotypes 16 and 18 20

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23 BENIGN PROSTATIC HYPERTROPHY Urinary Retention Symptoms Hesitancy, frequency, nocturia, incomplete emptying Due to compression of urethra by enlarged prostate Most of the enlargement is periurethral 23

24 Etiology Unknown? Disturbance of androgen-estrogen ratio? Stromal induction Gross Smooth or nodular Firm, elastic or rubbery consistency Cut surface is moist, and milky fluid is usually seen Cystic and honey-combed areas are usual Marked nodularity 24

25 Microscopic Greatly increased number of acini Increased size of acini Saw-toothed appearance of acini Preservation of double cell layer inner - epithelium, usually columnar outer - basal cells Increased amount of fibromuscular stroma 25

26 Most of the hyperplasia occurs in the Most of the hyperplasia occurs in the periurethral portion of the gland. 26

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28 Carcinoma of Prostate Unknown ETIOLOGY Somehow related to androgens Genetic Factors Racial differences Familial carcinomas Environmental factors 28

29 PRESENTATION Most cases in US detected following workup of abnormal PSA Rarely, urinary tract symptoms Bone pain in advanced cases Gross Gland may be normal, large, or small Most cancers occur peripherally, in the subcapsular region Cancer is usually gray-white, hard, and gritty. Loss of nodularity. Ill-defined borders. 29

30 Microscopic > 95% are adenocarcinomas Grading Mostofi I III nuclear features Gleason pattern 30

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33 T= local extent TNM STAGING T2-organ confined T3-extracapsular or seminal vesical invasion T4-invasion of bladder or rectum N=regional nodes M=distant metastsis 33

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36 PIN Prostatic Intraepithelial Neoplasia Architecturally benign acini or ducts lined by cytologically atypical cells Precursor Lesion for some? Most cancers Repeat biopsy recommended 36

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